Nutrition to Optimize Health, Now and in the

Future

© 2017 Pearson Education, Inc.

Demographics of US Older Adults

• Age 65 years and older (16% of US population)

• Age ≥85 years (2% of US population):

• "Very elderly" or "oldest of the old“

• Fastest growing US population

subgroup.

• Centenarians: 0.01% of US

population

• “Super centenarians”: Older than 110 y!

• All numbers and percentages expected to

increase greatly over next 30 years

• Average U.S. life expectancy = 78.8 years

Where do YOU fall in this spectrum????© 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Aging Process: Lifestyle Factors

• Biological age can be influenced by personal

choices. Negative influences include

• Smoking

• Excessive alcohol

• Excessive sun exposure

• Obesity

• Sedentary lifestyle

• Possibly excessive emotional

stress

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Age Related Changes in Sensory Perception

• Senescence: age-related processes that

increase risk of disability, disease, and death

• Systems begin to slow and degenerate

• Declined odor, taste, and visual perception

• Dysgeusia: abnormal taste perception

• Loss of visual acuity

• Support of family and friends helps

older adults with food selection and

preparation techniques

• How might these sensory changes impact food

acquisition, preparation, consumption?

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Age Related Changes in GI Function

• Xerostomia: declined salivary production

• Dysphagia: difficulty swallowing foods

• Achlorhydria: low gastric

HCl production, limits calcium cCa, ,

iron, folate, B12 absorption

• Gut microbiota changes ("aging gut"), resulting in

• Increased inflammation

• Decreased gut immunity

• Impaired gut mucosal cells

• "Anorexia of Aging”

• Lactose intolerance

• How might these changes

impact food choices,

preparation, consumption?

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Age Related Changes in Body Composition

• Increased body fat,

• Decreased muscle and lean tissue

• Sarcopenic obesity

• Bone mineral density declines

• How might these changes impact

nutrient needs?

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Macronutrient Guidelines for Healthy Older

Adults: Protein, fat, CHO

• Decreased energy needs from loss of muscle

mass and lean tissue due to:

• Lower basal metabolic rate

• Reduced activity levels

• Recommendations for proportions of fat,

carbohydrate, proteins: same as for younger

adults

• Likely that older adults need more protein

relative to body weight

• Older adults can eat slightly less fiber

© 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Additional Micronutrient Guidelines for

Healthy Older Adults

• Zinc recommendations stay the same

• Vitamins C and E recommendations stay the same

• Adequate intake of B-vitamins (B12, B6, and folate)

is a special concern

• Vitamin A should not be consumed in excess of

RDA (tends to accumulate

and increase risk of toxicity)

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Supplements

• Many/most older adults benefit from

multivitamin/multimineral supplement

• AREDS 1 and 2-based supplements for “eye

health” (reduces risk of cataract and macular

degeneration)

• Single nutrient supplements may be beneficial in

some cases

• Oral or injectable Vitamin B12

• Calcium

• Vitamin D

• High-potency supplements pose risks

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Supplements to Avoid

• Iron (unless prescribed by medical practitioner)

• High potency Vitamin A

• High potency B-complex

• Unproven herbals

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Fluid Guidelines for Older Adults

• Impaired thirst mechanism means most older

adults fail to recognize dehydration

• Many medications contribute to dehydration

• Fear of night-time urination contributes to

“voluntary dehydration”

• Urine should be color

of file folder!!

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Overweight and Obesity in Older Adults

• Increases severity and consequences of

osteoarthritis

• Further increases risk of diabetes, heart disease,

high blood pressure and certain cancers

• Limits mobility

• Causes functional declines in daily activities

• Further impairs cognition

• Weight loss improves functional status

• Dietary intervention, exercise always first

intervention. Medication and surgery

appropriate for medically at risk elderly.© 2017 Pearson Education, Inc.

Underweight in Older Adults

• Fewer protein reserves for post-surgical or acute

illness recovery

• Risk for poor wound healing and a depressed

immune response

• Geriatric failure-to-thrive: "the dwindles“

• Rate of death actually higher for inappropriately

underweight older adults vs. overweight older

adults

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• The nine Ds of geriatric weight loss.

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Osteoporosis

• In women, often diagnosed after menopause as

estrogen levels sharply decline

• In men: linked to declining testosterone levels,

steroid therapy, and alcohol abuse

• Most serious risk: hip fracture

• Osteoporosis treatment: vitamin D and calcium

supplementation, resistance training,

medications

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Genetic, Dietary Risk Factors

• Lifelong low body weight, small frame

• Asian, Caucasian heritage

• Lifelong inadequacy of Ca, Vit D, F, B, Mg

• Inadequate protein intake; low Vit K

• Excess Vitamin A [usually supplements]

Lifestyle Risk Factors

• Lifelong or recent physical inactivity

• Alcohol abuse, excessive caffeine

• >2c coffee/d or equivalent caffeine intake/d urinary Ca [short term]

• Ca intake <800mg/d plus 2c coffee/d led to increased bone loss.

• Smoking

• Females: Premature menopause; amenorrhea as teen

• Males: Low testosterone production

• Certain medications [corticosteroids]

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Low Risk Lifestyle Interventions:

Calcium/Vit D Supplements and Exercise!

• “Divide and conquer” : use <500mg Ca/dose; 2-3 times/d. Aim for about 1,000 mg/d (plus what is in your diet). AVOID EXCESS (over 2,000 mg/d)

• Ca carbonate/citrate/malate all well absorbed – found in Ca-fortified orange juice, etc.

• Avoid oyster shell and bone meal supplements – they may be contaminated with lead and/or other heavy metals

• Vit D improves Ca absorption; aim for 1500-2000 IU/d

• Weight bearing exercise on a daily basis (if safe)

• Medication often needed for optimal bone health

Dietary Guidelines to Reduce Risk of Late-

Life Onset of Cognitive Impairment

• Limit intakes of saturated and trans fats

• Optimize intakes of legumes, fruits, vegetables

(Mediterranean Diet)

• Optimize Vit E intake from foods (seeds, nuts,

green leafy vegetables, whole grains) vs. pills

• Daily intake of Vit B-12 supplemented foods (eg

cereal, soy milk) or B-12 supplements (alone or

within MVMM)

• Avoid iron supplements (unless prescribed)

• OPTIMIZE physical activity and fitness!!!!!

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Medication Usage by Older Adults

• Medications impact nutrient status; nutrient

intake/status impact medication effectiveness

• Polypharmacy: more than five prescription

medications at once

• Excessive polypharmacy: more than ten

prescription medications at once

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How Medications Impact Nutrient Status

• Increase or decrease food intake

• Alter taste perception, saliva production

• Decrease nutrient absorption, transport,

activation, storage, and/or retention

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Nutrient Intake/Status Impacts Medication

Effectiveness

• Obesity reduces effectiveness of lipid soluble

drug distribution to target tissues

• Specific nutrients, supplements and herbals can

increase or decrease normal rate of drug

degradation (leads to under- or over-

medication). Alcohol delays degradation of

many pain medications.

• High fat, protein, fiber meals delay gastric

emptying which exposes oral drugs to high acid

stomach fluids (decreases drug activity)

© 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Social Concerns Among Older Adults

• Elder abuse and neglect

• Food insecurity and hunger

• Social isolation

• Unique needs of elderly

immigrant populations

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“Best” Dietary Patterns for Long Term

Health?

• DASH Diet

• Mediterranean Diet

• Flexitarian Diet

• Lacto-ova vegetarian Diet

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DASH Diet

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Food Profile of the Mediterranean Diet

• Fresh fruits and vegetables

• Whole grain breads/cereals/pasta

• Legumes, nuts, seeds

• Olive oil

• Emphasis on fish and poultry vs. red meats

• Inclusion of dairy (yogurt, cheese)

• Inclusion of alcohol in moderate amounts

• Liberal use of herbs and spices in place of salt